Telford Veterinary Hospital

78 Souderton Hatfield PikeSouderton, PA 18960

(215)721-6989

www.telfordvet.com

The New Pet Form is an abbreviated version of the New Client Form designed for existing clients who adopt or purchase a new pet. This form should take about half the time to complete as it removed duplicate information saving you time. Please note is will ask for your Client ID number which is listed on all invoices, estimates, discharge instructions and any correspondence generated from this hospital. If you have any questions, please feel free to call the office and we'll be more than happy to help you out. We look forward to serving you soon.

New Pet Form

CLIENT'S INFORMATION

Client's Name (required)

First Name (required)

Last Name (required)

Client ID Number (required)

E-Mail Address (required) :

Address (required)

Street Address (required)

City (required),

State / Province (required)

Zip / Postal Code (required)

Phone (required)

Phone Type

Phone Number (required)

PET'S INFORMATION

Pet's Name (required)

Species (required)

CatDogOther

If "other" is selected for species, please specify below

Breed (required)

Color (required)

Date of Birth (Approximate) (required)

Sex (required)

Intact MaleNeutered MaleIntact FemaleSpayed FemaleUnknown

PET QUESTIONNAIRE

Prior Ownership (required)

Pet storeBreederRescueSPCAPrivate HomeOther

If "other" is selected, for prior ownership, please specify below

Does your pet have a Microchip (required)

YesNo

Does your pet have any serious allergies to medications or vaccines? If so, to what? (required)

Has your pet had any serious illnesses or injuries? If so, what and when? (required)

HEALTH RECORDS

*DOG OWNERS COMPLETE

Rabies Vaccine

Distemper Vaccine

Kennel Cough Vaccine

Lyme Vaccine

Heartworm Test

Fecal Test

*CAT OWNERS COMPLETE

Rabies Vaccine

Distemper Vaccine

Leukemia Vaccine

Leukemia Test

Fecal Test

Please include any additional information regarding your pet that you feel may be important to us.